Tension-type Headache Research Articles

Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache.

Although past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders. To examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC). This was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024. First-time headache diagnoses identified from inpatient hospitalizations, emergency department visits, and outpatient specialty clinic visits using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Diagnostic codes from the ICD-10 were used to identify attempted suicide from the Danish National Patient Registry and the Danish Psychiatric Central Research Register and completed suicides from the Danish Register of Causes of Death. Absolute risks (ARs) and risk differences (RDs) for attempted and completed suicide were calculated using the cumulative incidence function. Hazard ratios (HRs) for attempted and completed suicide associated with headache diagnosis were computed adjusting for age, sex, year, education, income, baseline comorbidities, and accounting for competing risk of death. In total, 119 486 persons (83 046 female [69.5%]) diagnosed with headache were identified and matched with 597 430 persons (415 230 female [69.5%]) drawn from the general population. Participants' median (IQR) age was 40.1 (29.1-51.6) years. The 15-year AR of attempted suicide among persons diagnosed with headache was 0.78% (95% CI, 0.72%-0.85%) vs 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (RD, 0.45%; 95% CI, 0.39%-0.53%). The 15-year AR of completed suicide among persons diagnosed with headache was 0.21% (95% CI, 0.17%-0.24%) vs 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD, 0.06%; 95% CI, 0.02%-0.10%). The hazards of attempted suicide (HR, 2.04; 95% CI, 1.84-2.27) and completed suicide (HR, 1.40; 95% CI, 1.17-1.68) were elevated among persons with headache vs comparison cohort members. Findings were consistent across headache types, with stronger associations for TACs and posttraumatic headache. Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.

An analysis of the burden of migraine and tension-type headache across the global, China, the United States, India and Japan

BackgroundRecurrent headaches in headache disorders adversely impact quality of life and job. Migraines and tension-type headache TTH) are the most common primary headaches and a prominent cause of disability globally. However, few research compare headache illness burden in China, India, the United States (US), and Japan.MethodsGlobal and Chinese, the US, Indian, and Japanese migraine and TTH incidence, prevalence, and disability-adjusted life years were taken from the GBD database for 1990–2021. The data is studied utilizing decomposition analysis, health inequality research, joinpoint regression model, and Bayesian Average Annual Percentage Change (BAPC) model.ResultsThe study found that migraine mostly affects women aged 15–49, while TTH are evenly distributed across gender and age. The worldwide average annual percentage change (AAPC) in disease-adjusted life years (DALYs) for migraine and TTH from 1990 to 2021 was 0.0357, a statistically significant trend (p < 0.001), as determined using joinpoint analysis. China exhibited the quickest rise in migraine and TTH incidence and prevalence, as well as the age-standardized rate (ASR) of DALYs, of the four nations analyzed. The US had the highest value of these indicators. Forecasting models reveal that without policy action, migraine prevalence will grow but TTH prevalence would stay unchanged. Decomposition research showed that population expansion is the major cause of migraines and TTH, which will be slightly alleviated by population aging. Health disparities across economic growth areas lessened between 1990 and 2021, according to the report.ConclusionGlobally and in China, migraine and TTH incidence and burden have increased since 1990. Migraines are becoming more common in young and middle-aged women, so headache treatment professionals should invest more in patient education to raise awareness and improve self-management to reduce disease burden and medical costs.

Can Headache Be a Symptom of Celiac Disease?: A University Hospital Experience

Aim: The purpose of this study was to determine the prevalence of Celiac disease in pediatric patients presenting with headache. However, little is known about the co-morbidity of Celiac disease and headache. To our knowledge, this is the first prospective pediatric study that systematically reviews this topic. Method: Two hundred forty four patients referred to the Pediatric neurology clinic of Adıyaman University Training and Research Hospital between January 2021 and November 2022 were examined. Gender, age, type of headache, Celiac serology, and other laboratory parameters of the cases meeting the inclusion criteria were recorded. Upper gastrointestinal endoscopy was performed on patients with positive Celiac serology. Patients whose results were compatible with Celiac disease were placed on a gluten-free diet. Results: The study group consisted of 202 patients, 123 girls (60.9%). The patients’ mean age was 12.67±3.524 years. Tension-type headache was determined in 121 (59.9%) of the patient group, and migraine type in 81 (40.1%). Celiac disease was detected in 5.4%. Vitamin B12 were 211±79.1 pg/ml, ferritin 19.5±13.9 ng/mL, and vitamin D 17.6±9.86 ng/ml (n=193). Interestingly, all patients who were diagnosed with Celiac disease reported that headache complaints decreased with the diet, However, no statistically significant correlation was found between any laboratory finding and headache type. Conclusion: Although it is still controversial whether headache is common in children with celiac disease, the results of our study showed that neurological symptoms improved after gluten-free diet in children presenting with headache and diagnosed with celiac disease. Celiac disease should be investigated in persistent headache despite pharmacological treatment.

Neck pain associated with headache attributed to rhinosinusitis: an observational study

ABSTRACT Background Neck pain is common among people with headache, including migraines, tension headache, and cervicogenic headache. Neck pain has also been associated with self-reported sinus headache in individuals who were not formally diagnosed with headache attributed to rhinosinusitis (HAR). Neck pain, in individuals diagnosed with HAR according to the International Classification of Headache Disorders, has not been investigated. Objective The primary objective of this study was to compare the report of neck pain in people with and without HAR. A secondary purpose was to compare measures of cervical musculoskeletal dysfunction between groups. Methods This was an observational study. There were 80 total participants, age and sex-matched with 40 per group. HAR group participants completed the Headache Impact Test, Sino-Nasal Outcome Test-22, Neck Disability Index (NDI), and Visual Analog Scale Score (VASS) to rate headache. All participants underwent examination of neck range of motion, neck muscle endurance, and segmental examination. Results There were significant between-group differences for reported neck pain (82.5% in HAR group; 22.5% in control group, p < .001) and NDI score (mean difference [95% CI] = 15.7 [11.1, 20.2], p < .001). There was a moderate and significant positive correlation between HAR and segmental dysfunction in the upper cervical spine (O-C3) (0.425, p < .001) but not the lower cervical spine. Conclusion Neck pain may be associated with HAR, and patients perceive this neck pain as impacting their quality of life. Upper cervical segmental dysfunction was common and significantly different in the HAR group. Causation of both the subjective and objective findings remains unclear.

Altered brain functional connectivity in patients with tension-type headache.

To evaluate whether patients with tension-type headache (TTH) exhibit abnormal brain functional connectivity compared to healthy controls. TTH is one of the most prevalent headache disorders throughout the world. The present study delves into brain functional connectivity in patients with TTH to enhance the understanding of its underlying pathophysiology. A cross-sectional study was conducted, enrolling patients with TTH diagnosed in line with the International Classification of Headache Disorders, 3rd edition beta criteria and a cohort of healthy controls (HCs). We used four metrics-global brain functional connectivity, functional connectivity, Granger causality analysis, and dynamic functional connectivity-to evaluate alterations of functional connectivity patterns in patients with TTH from both static and dynamic perspectives. Furthermore, correlational analyses were performed to explore the relationships between abnormal brain activities and clinical characteristics. A total of 33 patients with TTH (mean age = 42.3; 13 males/20 females) and 30 HCs (mean age = 37.1; 13 males/17 females) were included in the current study. Compared to HCs, patients with TTH showed altered global brain functional connectivity in the right dorsolateral superior frontal gyrus (SFGdor, t = 4.60). Abnormal functional connectivity was also detected between the right SFGdor and the right superior temporal gyrus (t = 4.56). Furthermore, the right SFGdor exhibited altered information flow with several brain regions, including the left precuneus (t = 5.16), right middle temporal gyrus (MTG, t = 4.72/-4.41), right inferior temporal gyrus (t = 4.64), right caudate nucleus (t = 4.09), and right thalamus (THA, t = -4.04). In terms of dynamic functional connectivity, disconnection was observed between the right SFGdor and the right MTG (t = -3.10), right Rolandic operculum (ROL, t = 3.60), left opercular inferior frontal gyrus (t = -3.48), and left medial superior frontal gyrus (t = -3.00). In addition, the correlation analyses revealed that activities in the MTG (r = 0.48), THA (r = -0.38), and ROL (r = 0.36) were significantly correlated with disease duration, while THA activity was associated with Visual Analogue Scale scores (r = 0.50). This study revealed alterations in both static and dynamic brain functional connectivity in patients with TTH within regions implicated in sensory perception, emotional processing, cognition, and pain regulation. These results may promote the understanding of the neural networks involved in TTH and potentially inform future therapeutic approaches for the condition.

The burden of headache disorders among medical students in Vietnam: estimates from a cross-sectional study with a health-care needs assessment

BackgroundIn our previous study, we demonstrated that headaches are highly prevalent among medical students in Vietnam. In the present study, we provide estimates of the associated symptom burden and impaired participation, utilizing these estimates to assess headache-related healthcare needs within this population.MethodsThe study followed the standardized methodology established by the Global Campaign against Headache. Participants included medical students who were randomly selected from two medical universities in Vietnam. Data collection utilized the HARDSHIP questionnaire, which included diagnostic questions based on ICHD-3 criteria, measures of symptom burden, quality of life (QoL) assessments using the WHOQoL-8, evaluations of impaired participation through the HALT index, and questions about headache yesterday (HY). The definition of health care “need” was based on the likelihood of benefit from intervention, including all participants with probable medication-overuse headache (pMOH), other headaches occurring on ≥ 15 days/month (H15+), migraine on ≥ 3 days/month, or migraine or tension-type headache (TTH) meeting at least one of two criteria related to symptom burden and impaired participation.ResultsA total of 1,362 participants (57.3% female) were included, of whom 1,125 students (61.3% female) were diagnosed with a headache disorder, and 165 students (69.1% female) reported experiencing a HY. The mean frequency of any headache was 3.6 days per month, with an average duration of 5.3 h, and 58% of participants reported an intensity of moderate/severe. For all headache, the mean pTIS was 2.8%. The mean number of lost days over a period of 3 months was 4.3 for work/school tasks, 3.8 for household chore, and 1.7 for social or leisure activities. Among those reporting a HY, 35.8% were able to complete less than half of their expected activities, while 9.7% could complete none. QoL of students with any headache was significantly lower than that of students without headache. A mong students with headache, 43.8% fulfilled atleast one of our needs assessment criteria.ConclusionsThis first study on headache burden in Vietnam reveals substantial symptom burden alongside a correspondingly high level of impaired participation among medical students.

Consistency between headache diagnoses and ICHD-3 criteria across different levels of care

BackgroundDiagnosing headache disorders poses significant challenges, particularly in primary and secondary levels of care (PSLC), potentially leading to misdiagnosis and underdiagnosis. This study evaluates diagnostic agreement for migraine, tension-type headache (TTH), and cluster headache (CH) between PSLC and tertiary care (TLC) and assesses adherence to the International Classification of Headache Disorders 3rd edition (ICHD-3) guidelines.MethodsA retrospective, cross-sectional analysis was conducted at Charité - Universitätsmedizin Berlin’s tertiary headache center. The patients’ self-reported diagnoses from the PSLC were compared with those in TLC and with ICHD-3 criteria. Cohen’s kappa (κ) and R² were used to assess diagnostic agreement.ResultsAmong 1,468 patients (43.4 ± 14.4 years; 74.5% women), 69.5% reported a diagnosis in PSLC, and 99.5% were diagnosed at their first TLC visit. Overall agreement between PSLC and TLC was 80% (κ = 0.55; R²=30%). Agreement between the PSLC and ICHD-3 was 77% for migraine, 82% for TTH, and 96% for CH (κ = 0.65; R²=41%). TLC diagnoses aligned with ICHD-3 in over 90%.ConclusionOur findings indicate a significant degree of diagnostic agreement across different levels of care according to the ICHD-3 guidelines. However, there remains insufficient reliability in clinical diagnostics, highlighting the need for continued efforts to improve the early recognition and diagnostic accuracy and consistency of primary headaches to optimize patient care and treatment outcomes in Germany.

Relative frequency of primary headaches in patients with neuromyelitis optica spectrum disorder: A cross-sectional study

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD. Methods: This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3). Results: Eighteen patients (15%) reported headaches, all of whom were women. The average age of these patients was 41.27 ± 11.33 years, and the average onset age of NMOSD was 34.60 ± 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 ± 1.42) than those with tension headaches (4.20 ± 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis. photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57% of migraine sufferers and 50% of tension headache sufferers. Conclusion: Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.

A comprehensive assessment of headache characteristics, management, and burden of migraine in comparison with tension-type headache in Türkiye: Results of a cross-sectional survey of adult patients.

Migraine is a common cause of headache and a leading cause of morbidity in Türkiye. This study aimed to describe the clinical characteristics and management of migraine and to compare migraine with tension-type headache (TTH) regarding the burden of disease and healthcare resource utilization. A total of 1368 patients (aged 18-65 years) with migraine or TTH were surveyed regarding sociodemographics, headache characteristics, clinical management, disease burden, quality of life, and healthcare resource utilization within the previous 12 months. Data from 1053 patients meeting the criteria for definite migraine (dMIG) or definite TTH (dTTH) were analyzed. The frequency and duration of attacks, the number of monthly headache days, days with analgesic consumption, and headache severity were significantly higher in dMIG compared to dTTH. Only 36.8% of definite migraineurs experiencing ≥4 monthly headache days were on preventive treatment. The negative impact on quality of life and economic loss were also higher in dMIG. Although more patients with dTTH visited a physician in the previous year, the number of physician visits was higher in dMIG. The groups were comparable regarding the percentage of patients who underwent radiological investigations due to headache; however, patients with dMIG had more brain magnetic resonance imaging and computed tomography scans. Timely and accurate diagnosis and optimal management of migraine are crucial due to its significant burden. Educational programs for patients and healthcare providers, along with adherence to and persistence with preventive medications, may improve clinical outcomes.

Quality of Life Assessment in Primary Headache Patients with Headaches Related to Abuse Using Scales and Questionnaires

This study, conducted between 2022 and 2024 in Tashkent, Uzbekistan, assessed 100 patients with abuse headaches (AH), split into two groups: those with migraine-induced AH and those with tension-type headache (TTH)-induced AH. Using standardized tools such as the VASH scale, HALT-90 index, LDQ scale, and McGill Pain Questionnaire, the study measured pain intensity, drug dependence, and functional impairment. Results revealed that migraine-induced AH caused more severe pain (VASH: 8.6±1.47) and greater productivity loss (HALT-90: 23.35±14.82) compared to TTH-induced AH. Women, especially of working age, were predominantly affected. Both groups showed moderate drug dependence, with higher levels in TTH patients. These findings highlight the need for integrated pain management strategies to reduce medication overuse and improve patient quality of life. Future research should explore lifestyle and psychosocial factors, with long-term studies needed to evaluate alternative treatment approaches for both migraine- and TTH-induced AH.

Beyond Migraine, Tension, and Cluster Headaches: The Other Primary Headaches

Beyond Migraine, Tension, and Cluster Headaches: The Other Primary Headaches

Headache attributed to transient ischemic attack: Assessment of its characteristics, associated factors and considerations on the diagnostic criteria.

Between 10% and 36% of patients with transient ischemic attack present with headache. Little is known regarding the characteristics of this headache. To assess the frequency of headache attributed to transient ischemic attack, its characteristics, and its associated factors, and whether the third edition of the International Classification of Headache Disorders criteria are adequate for diagnosing this headache. This was a cross-sectional study that included patients consecutively admitted within 72h of the onset of transient ischemic attack. A semi-structured questionnaire was used and all patients underwent magnetic resonance imaging. A total of 44 patients with a median age of 66years (P25- P75: 59.5-77) were included in the study, of whom 55% were male. The frequency of headache attributed to transient ischemic attack was 34.1% (95% CI: 20.5-49.9%), and the most common characteristics were insidious onset (67%), often after focal neurological symptoms (47%), was bilateral (60%), of moderate intensity, with a pattern similar to tension-type headache (67%). One patient reported experiencing a thunderclap headache. Headache attributed to transient ischemic attack was not associated with any sociodemographic variables, any previous headaches, or the severity or etiology of transient ischemic attack. Only 13% of patients with headache met the International Classification of Headache Disorders criteria for headache attributed to transient ischemic attack. There is a high frequency of headache attributed to transient ischemic attack. The current diagnostic criteria for this headache are inadequate for its characteristics.

Update on Tension-type Headache

Update on Tension-type Headache

Effects of Eyeball Tracking Exercises with Neuromuscular Postural Control Exercise Program on Chronic Neck Pain Patients with Tension Headache: A Randomized Controlled Trial

Effects of Eyeball Tracking Exercises with Neuromuscular Postural Control Exercise Program on Chronic Neck Pain Patients with Tension Headache: A Randomized Controlled Trial

Evaluation of vascular photobiomodulation for orofacial pain and tension type headache following COVID 19 in a pragmatic randomized clinical trial

This pragmatic double-blind randomized clinical trial aims to assess the impact of vascular photobiomodulation on post-COVID-19 patients experiencing tension-type headache, orofacial pain, or both persisting for more than 3 months. Participants were divided into two groups: vascular photobiomodulation (VPBM) and simulated VPBM. Their conditions were evaluated using the Brief Pain Inventory (BPI), Visual Analogue Scale, and Headache Impact Test (HIT-6). Data analysis included both inter and intragroup assessments, employing per-protocol and intention-to-treat analyses. Significant differences were observed in pain levels pre- and post-treatment and between the two groups. These differences were evident in the average pain experienced in the previous week (p = 0.010) and various dimensions of the BPI questionnaire, such as the degree of pain interference with walking (p = 0.011), work (p = 0.009), sleep (p = 0.012), and enjoyment of life (p = 0.016). However, there was no statistically significant difference in headache impact on activities of daily living as measured by the HIT. Vascular photobiomodulation shows promise in reducing pain and enhancing the ability to engage in daily activities among post-COVID-19 patients experiencing persistent headaches and orofacial pain.

General physical impairments in migraine patients beyond cervical function

Previous research has focused on the possibility of cervical dysfunction in migraine patients, similar to what is observed in patients with tension-type headaches. However, there is no evidence concerning the physical function of other body regions, even though lower levels of physical activity have been reported among migraine patients. The aim of this study was to compare cervical and extra-cervical range of motion, muscular strength, and endurance, as well as overall levels of physical activity, between patients with chronic migraine (CM) and asymptomatic participants. The secondary objective included the analysis of associations between CM-related disability and various physical and psychological variables. A total of 90 participants were included in this cross-sectional study: 30 asymptomatic participants (AG) and 60 patients with CM. Cervical and lumbar range of motion, strength and endurance, as well as handgrip strength were measured. Headache-related disability, kinesiophobia, pain behaviors, physical activity level and headache frequency were assessed through a self-report. Lower values were found in CM vs AG for cervical and lumbar ranges of motion (p < 0.05; effect sizes ranging from 0.57 to 1.44). Also, for neck extension strength (p = 0.013; d = − 0.66), lumbar strength (p < 0.001; d = − 1.91) and handgrip strength (p < 0.001; d = − 0.98), neck endurance (p < 0.001; d = − 1.81) and lumbar endurance (p < 0.001; d = − 2.11). Significant differences were found for physical activity levels (p = 0.01; d = − 0.85) and kinesiophobia (p < 0.001; d = − 0.93) between CM and AG. Headache-related disability was strongly associated with headache frequency, activity avoidance, and rest, which together explained 41% of the variance. The main findings of this study suggest that patients with CM have a generalized fitness deficit and not specifically cervical dysfunction. These findings support the hypothesis that migraine patients have not only neck-related issues but also general body conditions.

Comparison of ocular posterior segment parameters in the pediatric population with migraine without aura and tension-type headache.

This study aims to compare the posterior ocular structure parameters in children with migraine without aura (MWA), tension-type headache (TTH), and a healthy control group. The study included 31 patients with MWA, 29 patients with TTH, and 38 healthy controls between 6 and 18 years of age. For all participants, the detailed eye examination and measurements including peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vessel densities and foveal avascular zone (FAZ) parameters measured by optical coherence tomography (OCT) and OCT-angiography (OCTA), were obtained from the patient files. The mean age was 12.1±3.3 years in MWA patients, 12.4±2.8 years in TTH patients, and 11.9±3.8 years in the healthy controls (p=0.844). Among the groups, the mean pRNFL thickness, CMT, and SCT values were lowest in the MWA group. However, this difference was not statistically significant (p=0.621, p=0.854 and p=0.201, respectively). The mean and four-quadrant (superior, inferior, temporal, nasal) pRNFL thicknesses, the CMT, and the SCT were not statistically significant between the groups (p=0.621, p=0.500, p=0.186, p=0.565, p=0.744, p=0.854 and p=0.201, respectively). The macular vascular densities were lower in MWA patients than in the other two groups, and there was a statistically significant difference between the groups only in the nasal quadrant of the deep retinal capillary plexus (p = 0.014). There were also no statistically significant differences between the groups in the superficial and deep FAZ area parameters (p=0.652 and p=0.985). This study suggested that differential diagnosis between MWA and TTH can be difficult in childhood, as these conditions, which can present with ocular symptoms, may also be characterized by changes in posterior segment parameters. Long-term studies incorporating OCT-A in larger patient populations may provide valuable insights into retinal changes associated with these two distinct headache spectrums.

Global and regional trends and projections of chronic pain from 1990 to 2035: Analyses based on global burden of diseases study 2019.

Chronic pain poses a significant public health challenge. We present the global and regional data on Prevalence, Incidence and Years Lived with Disability (YLDs) for Chronic pain from the Global burden of disease (GBD) study 2019 data and analyze their associations with Socio-demographic index (SDI), age, and gender, and the future trends from 2020 to 2035. Regional trends in the burden of chronic pain and its association with age, gender, and SDI were assessed from 1990 to 2019. Joinpoint analysis was employed to describe trends in chronic pain burden across different SDI regions. Additionally, the Bayesian Age-Period-Cohort model (BAPC) was used for predicting future trends. Age-standardized rates (ASRs) of prevalence, incidence, and YLDs were employed to quantify the burden of chronic pain. Between 1990 and 2019, a significant increase was observed in global prevalence and YLDs rates of chronic pain. Higher rates were found among females, whereas a faster rise was noted among males. Notably, Low Back Pain (LBP) and Migraine accounted for predominant YLDs globally, particularly among those aged 75 and above. A notable prevalence of Tension-type Headache (TTH) was observed among younger populations. Furthermore, ASRs for chronic pain were highest in high-SDI regions. Projections suggest an increase in headache ASRs globally for both genders from 2020 to 2035. From 1990 to 2019, the global burden of chronic pain increased significantly, with projections indicating a continued rise in headache burden over the next 15years, underscoring the need for heightened attention to these issues.

Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p&lt;0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p&lt;0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).

Cutaneous Allodynia is already present in young adults with headache

Introduction: Cutaneous Allodynia (CA) is a painful response to a non-nociceptive stimulus, which is considered a marker of central sensitization. Objective: To evaluate the frequency of CA in individuals with and without headache. Materials and Methods: Volunteers of both sexes, aged 18 to 30 years, with and without headache participated. Those with abuse of analgesics and anesthetic block in the last three months were excluded. A questionnaire with general data prepared by the author himself, the Headache Screening Questionnaire (HSQ) for headache diagnosis and the 12 item Allodynia were applied. Symptom Checklist/Brazil (ASC-12/Brazil) to assess the severity of CA. Quantitative variables were described by mean and standard deviation and qualitative variables were presented in frequency. Results: 60 individuals were evaluated, with n=30 in the headache group, with a mean age, weight and height of 23.06±4.97 years, 62.02±13.09 kg and 1.62±0.05 m 2, respectively, where n=19 (64%) with migraine and n=11 (36%) with tension-type headache (TTH); n=30 in the control group with a mean age, weight and height of 22.03±0.09 years, 58.55±11.85 kg and 1.63±3.09, respectively. A higher frequency of CA was observed in the headache group compared to the control group n=28 (93.33%) and n=7 (26%), respectively, with the most frequent severity in the headache and control groups being mild and moderate, respectively, greater severity was also observed in those with migraine compared to those with TTH. Conclusion: Young adult individuals with headache have a higher frequency and severity of CA compared to individuals without headache.